ADDMIRE Clinic

Updated 19 May 2023

The service is provided by Addmire Ltd.

Services were provided both in person and virtually. The appointments in person were usually taking place on Wednesdays and Fridays from a leased consulting room within shared premises at the following address:

West Byfleet Consulting Rooms,

Madeira Road,

West Byfleet,

KT14 6DH.

We visited the site as part of the inspection.

The provider is registered with the Care Quality Commission to provide the following regulated activity:

• Treatment of disease, disorder or injury

The service was set up in 2017 and offers assessments and treatment to children with neurodevelopmental needs. The service specialises in the diagnosis and treatment of ADHD and ASD. Most of their work is with children with ADHD. The service was developed to meet unmet demand for children’s ADHD/ ASD assessments, diagnosis and treatment.

Services are led by the clinical director, a consultant neurodevelopmental paediatrician, who has previously worked at a local NHS ADHD clinic for many years. The clinical director develops treatment plans following assessment and these may include medication. The consultant is supported by a speech and language therapist, a clinic co-ordinator, who provides support in the clinic, a clinic manager, an administrator and the registered manager. There is also an ADHD specialist nurse who works alongside the service.

Referrals are received directly from parents and carers and from other sources, such as GPs. Patients and carers are responsible for funding the assessments and treatment.

Initial assessments take place in person, but any follow ups may be virtual. Most patients and parents are local. The service accepts referrals of children and young people between the age of three to 19 years of age.

https://www.addmire.org/

How we inspected this service

Before the inspection visit, we reviewed information we held about the service. During the inspection we:

• visited the premises and looked at the quality of the environment,
• observed an appointment between the consultant and a child accompanied by their parent,
• spoke with the registered manager, the clinical director, the speech and language therapist, the clinic co-ordinator, the clinic manager, and the ADHD specialist nurse,
• spoke with nine parents and carers of patients who were using the service,
• reviewed 22 patient records,
• reviewed prescriptions management,
• reviewed four staff records,
• reviewed information and documents relating to the operation and management of the service.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 19 May 2023

This service is rated as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at ADDmire Clinic on 17 February 2023 as part of our inspection programme. This was the first inspection of this service.

The ADDmire Clinic is a specialist independent assessment and treatment clinic for children with neurodevelopmental needs, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).

The managing director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We spoke to nine parents and carers of patients who were using the service and they were complimentary about the service. They described compassionate and kind staff who offered effective treatment and support. Parents and carers told us that they have been involved in decisions about care and treatment for their children and they were listened to. However, some parents told us that they had to wait for a long time for an appointment, and a parent felt that the service can improve further by discussing other strategies apart from medication.

Our key findings were:

• The service did not always have clear systems to keep people safe and safeguarded from abuse. Staff did not assess risk appropriately or follow good practice with respect to patient safety.
• The service did not have systems and arrangements in place for managing prescriptions to minimise risks. The service was not carrying out any medication audits to assure themselves about the quality of their prescribing practices. Staff did not always ensure that appropriate physical health monitoring was carried out where required.
• Staff did not always assess the needs of patients and deliver care and treatment in line with national standards and guidance relevant to their service. The service did not actively participate in quality improvement work.
• The service did not have adequate governance processes in place, that allowed staff to review practice and risk areas for assurance, and to improve quality.
• There were no policies and procedures in place to identify what preemployment checks should be carried out for staff, and how these should be recorded in staff records. There was not a robust process in place, for the service to assure themselves that all staff were appropriately qualified and trained.
• There were no records of clinical supervision for staff. We found no evidence that clinical supervisions was happening, or how this was monitored.
• The service did not always obtain consent to care and treatment in line with legislation and guidance.
• The service did not always establish proper policies, procedures and activities to ensure safety and assure themselves that they were operating as intended. For example, there was no robust process in place to ensure policies and procedures were thorough, regularly updated by competent staff, and up to date with relevant national guidance.
• There was a lack of robust record keeping. The clinical notes we saw on the electronic patient records did not include a clear record of relevant discussions or updates.
• The service was not assuring themselves that equipment was maintained according to manufacturers’ instructions, and safety and emergency equipment checks were promptly completed.
• Staff were not always aware of what reasonable adjustments should be made to the environment, to meet all patients needs when needed. The provider felt that they were able to make reasonable adjustments for patients, when needed.
• The service did not have a policy in place regarding duty of candour, so it was unclear how the provider ensured compliance with the requirements of the duty of candour.

However,

• Staff treated patients with compassion and kindness, and understood the individual needs of patients. They helped patients to be involved in decisions about care and treatment.
• Most patients were able to access care and treatment from the service within an appropriate timescale for their needs.

Following this inspection, we served the provider with a Warning Notice, because we found that significant improvement was needed to ensure that the service had adequate governance processes in place, that allowed them to review practice and risk areas for assurance, and to improve quality. The lack of governance arrangements meant that not all risks were identified and acted upon in a timely way. The Warning Notice required the provider to make improvements to meet the legal requirements set out in the Health and Social Care Act by 09 June 2023.

In addition to the improvements identified in the Warning Notice, the areas where the provider must make improvements as they are in breach of regulations are:

• The service must ensure that there are clear systems in place to keep people safe and safeguarded from abuse. Robust risk assessments must be completed to demonstrate that risks are managed effectively to keep all patients safe. Regulation 12
• The service must ensure that there are systems and arrangements in place for the proper and safe management of medicines, and that the physical health of patients is assessed, monitored and managed effectively in accordance with patients’ needs. Regulation 12
• The service must ensure that care and treatment of service users must only be provided with the consent of the relevant person. Regulation 11
• The service must ensure that there are appropriate arrangements in place to meet the requirements set out in Regulation 20, Duty of Candour, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see full details of the regulations not being met at the end of this report.

The areas where the provider should make improvements are:

• The service should ensure that staff assess needs and deliver care and treatment in line with standards and guidance relevant to their service.
• The service should ensure that staff are aware of what reasonable adjustments could be made to the environment, to meet all patients when needed.

Serena Coleman

Interim Deputy Director